Wang Yu, Zhang Meng, Yu Yan, Han Tao, Zhou Ji, Bi Liqing
Department of Neurosurgery Intensive Care Unit.
Department of Critical Care Medicine.
Medicine (Baltimore). 2020 Nov 13;99(46):e23257. doi: 10.1097/MD.0000000000023257.
Critically ill patients with coronavirus disease 2019 (COVID-19) have a high case fatality rate. Hence, controlling the disease progression of severely ill COVID-19 patients to avoid the development of severe-to-critical COVID-19 is the most important target of COVID-19 treatment. The latest autopsy results of COVID-19 patients have shown the presence of viscous secretions in the airways. However, no studies are available that specifically describe and analyze the sputum characteristics and the effects of various sputum drainage methods on the prognosis of COVID-19 patients. In our study, we found that elderly COVID-19 patients were more susceptible to progression to critical illness (P = .024) and were likely to have accompanying lymphopenia (P = .035) or increased neutrophil counts (P = .019). We observed that there was a higher proportion of patients with Grade 3 sticky sputum in the critically ill group than in the noncritically ill group (P = .026), suggesting that changes in sputum characteristics may be one of the early warning signs of critical COVID-19. In addition, we found that the application rates of large doses of ambroxol (P = .043) and prone-position drainage (P = .037) were relatively high in COVID-19 patients with good prognoses, suggesting that the early application of large doses of expectorant drugs and prone-position drainage in COVID-19 patients may avoid progression to critical illness and improve the prognosis.
2019年冠状病毒病（COVID-19）重症患者的病死率很高。因此，控制重症COVID-19患者的疾病进展以避免发展为危重症是COVID-19治疗的最重要目标。COVID-19患者的最新尸检结果显示气道内存在黏稠分泌物。然而，尚无研究专门描述和分析COVID-19患者的痰液特征以及各种痰液引流方法对其预后的影响。在我们的研究中，我们发现老年COVID-19患者更容易进展为危重症（P = 0.024），并且可能伴有淋巴细胞减少（P = 0.035）或中性粒细胞计数增加（P = 0.019）。我们观察到，危重症组中3级黏痰患者的比例高于非危重症组（P = 0.026），这表明痰液特征的变化可能是COVID-19危重症的早期预警信号之一。此外，我们发现，预后良好的COVID-19患者中大剂量氨溴索的应用率（P = 0.043）和俯卧位引流的应用率（P = 0.037）相对较高，这表明在COVID-19患者中早期应用大剂量祛痰药物和俯卧位引流可能避免进展为危重症并改善预后。
